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General NPI Number Information
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NPI Number | 1962376616
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Entity Type | Individual
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Provider Name | JONGSOO LEE MD
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Gender | Male
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Dates
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Enumeration Date | 10/03/2025
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 9115 S TACOMA WAY STE 105
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City | LAKEWOOD
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State | WA
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Zip | 98499-4400
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Country | US
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Telephone | 253-581-4564
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Fax | 253-581-6484
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Provider Business Mailing Address
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Address Line | 9115 S TACOMA WAY STE 105
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City | LAKEWOOD
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State | WA
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Zip | 98499-4400
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Country | US
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Telephone | 253-581-4564
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Fax | 253-581-6484
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD.MD.70039970
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License Number State | WA
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